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THE QUESTION: Traditional screenings for breast cancer often miss tumors in women who have an inherited susceptibility to the disease. Tumors in these women also frequently develop between the recommended annual mammograms. Might magnetic resonance imaging (MRI) help achieve better results for these high-risk women?
THIS STUDY periodically screened 1,909 women via breast exams, mammograms, and MRIs for an average of three years. All participants, who averaged 40 years old, had an above-normal risk for breast cancer. Mammograms detected 18 cases of breast cancer, compared with 32 found by MRI. Breast exams detected about 18 percent of the more serious, or invasive, cases of breast cancer, compared with 33 percent for mammograms and 80 percent for MRIs.
WHO MAY BE AFFECTED BY THESE FINDINGS? Women who face a hereditary risk for breast cancer.
CAVEATS: MRI had a higher rate of false positives. The authors attributed more than twice as many unnecessary follow-up exams and three times as many unneeded biopsies to MRI as to mammogram. Also, the study was not randomized; an accompanying editorial said only a randomized trial could prove whether any particular screening method would improve survival rates. The results may not apply to women at normal risk for breast cancer.
BOTTOM LINE: Women with an inherited susceptibility to breast cancer may want to talk with their doctor about supplementing mammography with MRI.
FIND THIS STUDY: July 29 issue of the New England Journal of Medicine; abstract available online at www.nejm.org.
LEARN MORE ABOUT screening for breast cancer at breastcancer.org and cancer.org.
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Topical painkiller for arthritis
THE QUESTION: Over-the-counter lotions have become a popular choice of people looking for something to kill the pain of osteoarthritis, the degenerative joint disease sparked by the breakdown of cartilage that normally cushions a joint. Are these topical NSAIDs (non-steroidal anti-inflammatory drugs) effective?
THIS STUDY examined data from 13 randomized studies that compared topical NSAIDs with placebos and oral NSAIDs. The studies lasted up to four weeks and involved 1,983 participants with osteoarthritis, mostly involving the knee. Analysis showed that topical NSAIDs relieved pain and stiffness and improved overall functioning only during the first two weeks; there were no differences after that. Topical medications did not work as well as drugs taken orally during the first week. Participants had fewer gastrointestinal side effects from the lotions than from the pills, but they endured rashes, itching, and burning from the topical medications.
WHO MAY BE AFFECTED BY THESE FINDINGS? Anyone with osteoarthritis, which generally afflicts people middle-aged and older.
CAVEATS: The study did not distinguish among different types of NSAIDs (salicylic acid, diclofenac, ibuprofen, etc.), which could yield differing results. The authors stated that no studies had lasted longer than a month.
BOTTOM LINE: People with osteoarthritis may want to talk with their doctors about medication options for short-term and long-term relief.
FIND THIS STUDY: July 30 Online First issue of the British Medical Journal; abstract available online at www.bmj.com (click "Online First").
LEARN MORE ABOUT treating osteoarthritis at arthritis.org and mayoclinic.com.
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Conservative or aggressive?
THE QUESTION: Older people with coronary artery disease generally receive more conservative treatment than younger people. However, more aggressive or invasive treatment is considered life-saving for those who receive it. Might these techniques benefit older people as well?
THIS STUDY analyzed the results of 2,220 adults randomly assigned to either conservative or aggressive care after they were admitted to a hospital with symptoms of acute coronary artery disease. People treated conservatively were admitted for observation and given a stress test before discharge; aggressive care included angiograms to check for blockages and, if warranted, angioplasty, stenting, or surgery. Those aged 65 to 75 who received aggressive treatment had a 39 percent lower risk of heart attack or death within six months than did those of similar age who received conservative care. For people younger than 65, the risk reduction was 22 percent, and it was 56 percent for those older than 75. The oldest group, however, had more problems with major bleeding when treated aggressively.
WHO MAY BE AFFECTED BY THESE FINDINGS? Older people with coronary artery disease.
CAVEATS: People with additional diseases were excluded from the study, so whether the results would apply to less healthy people is unclear. Merck & Co., which partially funded the study, also employed three of the authors.
BOTTOM LINE: Older people with coronary artery disease may want to talk with their doctor about aggressive care.
FIND THIS STUDY: Aug. 3 issue of the Annals of Internal Medicine; abstract available online at annals.org.
LEARN MORE ABOUT coronary artery disease at nhlbi.nih.gov and clevelandclinic.org.
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